If you’re among those who think being a little
sleepy won’t kill you, consider a study published in the Journal of
the American Geriatrics Society in 2000: Among older people,
particularly older women, daytime sleepiness was associated with an
increased risk of death from any cause—greater than death from
illness, cardiovascular disease, heart attack and congestive heart
failure.

Rather than getting the eight hours of sleep a night that most
of us need, Americans on average sleep 6.8 hours on weekdays and
7.4 hours on weekends, according to the National Sleep Foundation’s
(NSF’s) 2005 Sleep in America poll. Lack of sleep is so rampant
that renowned sleep researcher William C. Dement, M.D., calls it a
hidden epidemic and says the United States is a “sleep-sick
nation.” The 2005 poll also found that 75 percent of adults
frequently exhibit signs of a sleep problem, such as taking more
than 30 minutes to fall asleep, excessive daytime sleepiness or
having trouble staying asleep.

Compared with the same poll in 1998, skimping on sleep has
become more common. Many respondents admitted that sleepiness
impaired driving skills and work performance and caused them to
stay home from work and other events. Fatigue also put a wet
blanket on sex drive. However, the majority of those surveyed
either ignored or downplayed these symptoms.

“People who are chronically sleep deprived can be completely
unaware of the root cause of their overwhelming fatigue,” says
Dement, a professor in the Department of Psychiatry at Stanford
University and author of The Promise of Sleep (Dell, 2000). This
chronic mismanagement of a vital bodily function leads to
accidents, illness and premature death. Sleep loss can impair
reaction times on par with alcoholic intoxication (at a blood
alcohol concentration of 0.08 percent, illegal for driving a motor
vehicle). According to the National Highway Traffic Safety
Administration, “Drowsy driving causes more than 100,000 crashes a
year, resulting in 40,000 injuries and 1,550 deaths.” Dement says,
“Drowsiness is a red alert to get off the road.” He adds that sleep
deprivation was a factor in the Exxon Valdez running aground in
1989, spilling 11 million gallons of crude oil.

A night or two of poor sleep will impair concentration and
memory, interfere with work and suck the air out of your social
life. Mood begins to erode. First come crabbiness, peevishness and
difficulty coping with everyday hassles, then a mounting
vulnerability to depression. Fending off infections becomes more
difficult. Worse, chronic sleep deprivation worsens diabetes and
heart disease.

If you’re tired most days, you might have an underlying problem
that disturbs your sleep, such as stress-induced insomnia, sleep
apnea or restless legs syndrome, among other problems. See your
doctor to rule out an underlying condition. For most people,
daytime fatigue usually derives from burning the midnight oil.
Because most doctors don’t think to ask about a patient’s sleep
habits, it’s up to you to consider sleep as important as diet and
exercise in maintaining your health.

Caffeine Sensitivity and Stress

Some people are more sensitive to caffeine than others. Caffeine
sensitivity correlates with being prone to stress-induced insomnia.
In one experiment, published in Sleep Medicine in 2007, a subgroup
of people who had trouble dozing off in the sleep lab (a
situational stress) also took longer to go to sleep after a
moderate dose of caffeine (3 mg per 2.2 pounds body weight)—about
two cups of coffee. People who are sensitive to caffeine are more
likely to have trouble falling asleep in times of stress. The
authors speculate that some people have a “trait vulnerability to
sleep disturbance from a very broad range of challenges to the
sleep system.”

Insomnia: A Common Concern

Some of us are tired because we don’t leave enough time for
shut-eye. One in four, however, have insomnia, defined as
difficulty either falling or staying asleep. Nearly one in 10 have
difficulty sleeping most nights.

Insomnia is a symptom, not a disease. Factors that increase the
odds of poor sleep include shift work, jet travel, stress, anxiety,
pain, menopausal hot flashes, an uncomfortable sleep environment,
consuming caffeine late in the day or excessive alcohol at night,
and taking medications, such as decongestants, cortisone-type
drugs, antidepressants, and drugs to lower blood pressure and
relieve asthma.

Stress tops the list. Insomnia caused by a temporary upheaval
(new job, romantic breakup, illness) often resolves once you’ve
recovered from that setback. A greater threat is the chronic
low-grade stress overscheduled Americans endure. We work too hard,
go to bed too late, toss and turn, and rise too early.

Robert Sapolsky, Ph.D., a Stanford University professor and
author of Why Zebras Don’t Get Ulcers (Owl Books, 2004), explains
that not only does stress thwart sleep, but insufficient sleep
itself acts as a stressor—it activates the stress response. The
stress response elevates two adrenal gland hormones: epinephrine
and cortisol. Heart rate, blood pressure, respiratory rate and many
mental activities speed up. Other visceral activities
(gastrointestinal and reproductive) slow down.

In one of life’s many ironic twists, the hormonal changes caused
by a sleepless night have a nerve-jangling effect, making it
difficult to sleep the next night, which activates the stress
response, which raises epinephrine and cortisol … it’s a vicious,
unhealthy cycle. Chronic stress can lead to immune dysfunction,
weight gain, diabetes, osteoporosis, memory problems and mood
disorders. Sapolsky acknowledges that chronic activation of the
stress response may contribute to the maladies associated with
inadequate sleep.

Getting the Hang of Sleep

While some people reach immediately for prescription or
over-the-counter sleep aids, medications aren’t the only—and
probably not the healthiest—way to treat insomnia. For some people,
nondrug treatments can work as well or better. Although such
methods take longer to work, the benefits tend to be enduring.

“Know thyself,” Dement likes to tell haggard people. In other
words, figure out how you’re sabotaging your sleep. A standard
approach is to improve “sleep hygiene,” learn relaxation skills and
adopt positive strategies for late-night sleeplessness. Good sleep
hygiene means you allow for a good eight hours of slumber each
night, maintain regular sleep and wake times, create a cozy, quiet
and dark sleeping environment, and avoid afternoon and evening use
of stimulants, such as caffeine, and excessive alcohol at
night.

Although many health practitioners discourage vigorous exercise
just before bed, regular daily exercise can make your nights more
restful, according to a 1997 Journal of the American Medical
Association study. One study from the Journal of the American
Geriatrics Society found that tai chi helped older people who had
trouble sleeping. Yoga has helped people with chronic insomnia.

The hardest part of falling asleep can be turning off your busy
mind. At first, you can’t sleep because you’re thinking about
unfinished tasks from the day, regrettable bits of dialogue and
tomorrow’s Sisyphusian to-do list. Then you glance nervously at the
clock. How did it get to be 1 a.m.? You do the math; no way will
you get enough sleep. Maybe you won’t sleep at all. You picture
yourself stumbling through the next day, heavy-lidded and
dim-witted. Stress hormones rise. Your nerve cells begin to twitch,
mutter to themselves, grow five-o’clock shadows.

To avoid this scenario, Dement urges people to shun late-night
activities that disturb peace of mind, such as doing homework,
paying bills, watching the news and checking e-mail. The worst
scenario is doing these things in bed—a place you want to associate
only with sleep. If something’s on your mind, write it down, then
tell yourself to forget about it overnight.

Whenever you can, occupy your last hours with relaxing
activities, such as reading for pleasure. Make bedtime a sensuous
ritual. Light a candle, turn out the electric lights, put on
soothing music, and step into a warm bath or a hot foot soak. Try
adding 10 to 15 drops of calming essential oils to the tub. (See
“Soothe Yourself with Aromatherapy” on Page 44.) Focus on the
sensation of water lapping your skin, the plant fragrances, the
music, the candle’s flickering glow. Pat dry with a towel, and
massage oil (apricot, grape seed or almond) into your skin. Cover
the clock (and other light sources) and don’t look at it till
morning. Lie in a comfortable position and notice your breathing
slow down. To unclench your jaw, try parting your lips
slightly.

You also can try progressive muscle relaxation, an effective
technique used in many nondrug studies on insomniacs. Lie on your
back. Starting with your feet, contract the muscles (really clench
them), then relax. Appreciate what relaxation feels like. Next,
move up to your calves, thighs, buttocks and so on, right to your
face. Another method is to lie still with eyes closed and focus on
your breathing, saying to yourself “in” as you inhale and “out” as
you exhale. Dement’s own technique is to set the radio on the sleep
function (so that it turns itself off in 30 minutes) and let the
background chatter distract him from his own thoughts.

If you’re still wide-eyed after a half hour in bed, get up and
do something relaxing, such as reading, listening to soothing music
(which has proven sleep benefits), gently stretching or massaging
yourself with your aromatherapy oil. Do not reach for the liquor
cabinet, as alcohol disrupts sleep patterns. Emily Matuszewicz, a
chiropractor and the director of Metropolis Center for Holistic
Health in Denver, suggests getting out of bed and doing a calming
yoga pose. Her favorite is lying on her back with her buttocks
against the wall and her legs straight up the wall.

Herbs to Help You Get Your ZZZs

A number of herbs have sedative properties but do not interfere
with daytime function—their sedating properties are mild (see
exceptions below). Lesley Tierra, an acupuncturist and herbalist in
Santa Cruz, California, recommends that people with persistent
insomnia take herbs that support the nervous system three times
daily, in addition to a dose at bedtime. In general, a dose is a
cup of tea, 1/2 to 1 teaspoon of tincture or one to two capsules.
Check product labels for more details.

Some herbs are nerve tonics yet have no sedating effects. One
example is oats (Avena sativa). Eat oatmeal for breakfast and add
oatstraw or oat tops to your tea. Herbalist Rosemary Gladstar
writes in Rosemary Gladstar’s Family Herbal (Storey Books, 2001)
that oat tops are rich in minerals and “one of the highest
terrestrial sources of magnesium.” (Magnesium is thought to help
regulate the internal clock.)

Hawthorn (Crataegus spp.) is subtly calming, gentle and suitable
for long-term use. It also benefits the cardiovascular system. You
can take it in the form of jams and syrups, or as a tea, tincture
or capsule. Another herb that supports cardiac function is
motherwort (Leonurus cardiaca). Many herbalists favor it for
menopausal women awakened by heart palpitations.

To Medicate or Not?

If nondrug options don’t work for insomnia, medications can be
necessary and important, Dement says. Until recently, drug
treatment has been hampered by safety concerns. Hypnotic
(sleep-inducing) drugs are sedating, and, therefore, depress the
nervous system, slowing reaction times and clouding mental
functions. Many also carry the risk of addiction. Hence, experts
advise limiting their use to two weeks.

But what about people with stubborn, persistent insomnia? The
elderly are particularly vulnerable to insomnia due both to normal
age-related changes in sleep cycles and chronic illnesses. Older
people often already are on multiple medications, slow to
metabolize drugs in general and unsteady physically and mentally.
The risk of falls makes many doctors hesitant to prescribe a
hypnotic. However, a large 2005 study from the University of
Michigan Health System found that sleep-deprived, unmedicated
elderly insomniacs were more likely to fall than those able to
sleep thanks to hypnotics. Fortunately, some of the newer
hypnotics—Sonata (zaleplon), Lunesta (eszopiclone) and Ambien
(zolpidem)—appear to be safe to take long-term.

Many sleepless Americans reach for over-the-counter sleep drugs,
which typically contain sedating antihistamines. Experts say that,
not unlike alcohol, these drugs aren’t very effective, impair sleep
quality and can leave you foggy the next morning.

If anxiety or mild to moderate depression underlies your
sleeplessness, St. John’s wort (Hypericum perforatum) might be the
herb for you. (For any serious psychological disturbance, make an
appointment with a mental health professional. And be aware that
St. John’s wort speeds the liver’s metabolism of many drugs,
thereby lowering their blood levels, and thus, their
effectiveness.)

According to herbalist David Hoffmann, author of Medical
Herbalism (Element, 1996) and other books, the most effective sleep
inducers are California poppy (Eschscholzia californica), hops
(Humulus lupulus), passionflower (Passiflora incarnata) and
valerian (Valeriana officinalis). He finds them particularly useful
when pain interferes with sleep. I don’t recommend using these four
herbs during the daytime.

Valerian is the best-researched hypnotic—or sleep inducing—herb.
More than 20 clinical trials show the root extracts hasten sleep
onset and improve sleep quality, without side effects. Most studies
used valerian alone, but a few also found benefits for valerian
plus hops, lemon balm or kava (Piper methysticum). Valerian also
has compared favorably with the prescription drug Serax
(oxazepam).

Smart Choices for Sleepless Nights

The mineral magnesium is thought to help regulate the biological
clock, but many of us don’t get enough of it. Matuszewicz notes
that changes in agricultural practices have depleted magnesium from
our fruits, vegetables and grains. Because higher doses of
magnesium can loosen bowels, she suggests you start with 300 mg at
bedtime and move up to 400 to 500 mg. In a 2006 study of menopausal
women, magnesium in combination with magnolia bark extract reduced
sleep disturbances. Magnesium supplements also have been shown to
improve sleep among people with periodic limb movements and
restless legs syndrome.

Secreted by the pineal gland at night, the hormone melatonin
regulates several physiologic processes, including sleep-wake
cycles. In many people, this hormone declines with age. Blood
levels have been shown to be lower in elderly people with insomnia
than in people the same age without insomnia, according to a 2004
study from The American Journal of Medicine. Studies show that, at
least in elderly people with low levels, melatonin can improve
sleep. Not all studies are positive, however, and most experts
don’t consider it an effective remedy for run-of-the-mill
insomnia.

Because taking a bedtime dose might help reset the biological
clock, melatonin can help people who do shift work, travel by jet,
are blind or have delayed sleep phase syndrome (habitually going to
bed very late). Getting some morning sunshine also helps your body
set a normal sleep-wake cycle.

The specific dose for melatonin has yet to be clearly defined.
Usual recommendations are 0.5 to 3 mg 30 minutes to one hour before
bed. While no serious side effects have surfaced, there have been
reports of melatonin aggravating depression (with daytime use),
stimulating vivid and disturbing dreams and causing grogginess.
Most experts discourage its use in children, adolescents, women who
wish to become or are pregnant or in people with autoimmune
diseases.

Valerian is the best- researched sleep
herb.

A 2006 review of 16 studies, published in The American Journal
of Medicine, reported that valerian significantly improved sleep
and didn’t cause a morning hangover. However, the authors
criticized the methods of many studies, including the use of small
numbers of volunteers.

Don’t expect valerian to work instantly. When chronic insomniacs
took a single 600-mg dose one hour before bedtime, valerian did not
significantly affect objective or subjective measurements of sleep.
Fourteen consecutive nights of treatment did improve sleep
efficiency, though, according to a 2000 study published in
Pharmacopsychiatry. The take-home message: This herb seems better
suited to long-term maintenance of sleep.

Valerian’s notoriously musty taste drives most people to down
liquid extracts or capsules rather than teas (the herb’s scent has
been compared to dirty socks). Thirty minutes to an hour before
bedtime, take 1/2 to 1 teaspoon of tincture or 300 to 500 mg of a
concentrated extract containing no less than 0.5 percent volatile
oils. Warning: Herbalists note that some people are stimulated,
rather than relaxed, by valerian.

California poppy has a long tradition as an analgesic and
sedative. Laboratory studies show it reduces anxiety and induces
sleep. One study found that a French product called Sympathyl,
which contains California poppy, hawthorn and magnesium, was safe
and more effective than a placebo in treating mild to moderate
anxiety disorders.

Hops, a critical ingredient in beer, is mildly sedating. The
fluffy strobiles can be put into sleep pillows, along with fragrant
lavender. Gladstar, who finds hops’ bitter taste difficult to
disguise, takes the herb as a tincture, often in combination with
valerian. Keep the bottle at your bedside. That way, if you awaken
in the middle of the night, you can take a couple droppersful.

Sharon Tessier, who teaches aromatherapy and other holistic
health classes at Metropolitan State College of Denver, says her
favorite remedy for a hectic day is a cup of chamomile tea and a
warm bath. “If time does not permit a full body bath, I use a
shoulder pillow filled with flaxseeds, heat it in the microwave for
two minutes, put it around my neck, and make peace with my day
while I drink my tea.”

Lavender essential oil also has a good track record of
alleviating insomnia, a tradition verified by scientific research.
A 2006 Korean study of college women found that aromatherapy with
essential oil of lavender helped relieve insomnia. Another study
found that smelling lavender essential oil helped seniors maintain
sleep as they withdrew from benzodiazepines (a group of drugs that
includes Serax, Restoril, Valium and Halcion).

If you have time for a warm bath at night, Tessier recommends
you add 10 to15 drops of essential oil (half that amount for
elderly people and young children) and soak for at least 15
minutes. Inhale the wonderful aromas. Those volatile oils absorb
across your respiratory linings as well as across your skin. Note:
Tessier cautions that these potent plant medicines not be taken
internally and be kept out of children’s reach.

Magical Massage

Ashley Dew has personal experience with using massage for
insomnia. When stress-induced insomnia shadowed Dew’s college life,
her mother gave her a gift certificate for a massage. That night,
Dew slept like the proverbial baby. She left Savannah, Georgia, for
the Boulder College of Massage Therapy. A side benefit of being a
student afforded her twice weekly massages, which cured her
insomnia and anxiety. Now a certified massage therapist at
Metropolis Center for Holistic Health in Denver, Dew gets one or
two massages a month to stay healthy.

If you can’t afford regular massages, consider swapping with a
friend. And you always can massage yourself. Focus on your hands,
feet, temples, jaw, shoulders, neck and other reachable tight
muscles. The ideal is to have a massage right before bedtime—a
treat a generous loved one might provide.

Consider making a nighttime massage oil spiked with the
aforementioned calming essential oils. Tessier recommends 15 drops
of essential oil per one fluid ounce of carrier oil or 2 to 3 drops
per teaspoon of carrier. Halve the dilution for elderly people. For
small children, use one-third the amount of the adult formula.

Resources

Gaia Herbs
(828) 884-4242
www.GaiaHerbs.com

Herbs, Etc.
(888) 694-3727
www.HerbsEtc.com

Nature’s Benefit
(973) 890-2378
www.NaturesBenefit.com

Ridgecrest Herbals
(800) 242-4649
www.RidgecrestHerbals.com

Well-in-Hand
(888) 550-7774
www.WellInHand.com

Sleep: A Precious Elixir

Guard your sleep. Think of it as a precious elixir for health
and longevity. Try to eradicate any underlying sleep thieves.
Consider the long menu of possible remedies. Clean up your
behaviors, try herbs and, if needed, try a medication. Do whatever
works. Now, get some sleep! •

Linda B. White, M.D., is the coauthor of The Herbal Drugstore
(Rodale, 2000). She teaches botanical medicine and other health
classes at Metropolitan State College of Denver. She plans to take
her own advice about sleep seriously.

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